硫胺素,水溶性复合维生素B,在常量营养素氧化和细胞ATP的产生中起辅酶的作用。数据表明,硫胺素耗竭发生在心力衰竭(HF)中。因此,在HF患者中补充硫胺素可以改善心脏功能。
我们试图确定口服硫胺素补充剂是否能改善左心室射血分数(LVEF),运动耐受力,HF和LVEF降低患者的生活质量。
在这个前景中,多中心,双盲,安慰剂对照随机对照试验,在2010年至2015年期间,我们从4家学术和社区医院招募了符合资格的HF和LVEF降低的非卧床患者.参与者被随机分配接受每天200mg口服单硝酸硫胺或安慰剂6个月。
69名患者(平均±SD年龄:64±12岁;83%男性;LVEF:37%±11%)被随机分配:34名接受安慰剂,35名接受硫胺素补充剂。在6个月时,补充组的红细胞焦磷酸硫胺素和尿硫胺素浓度显着高于安慰剂组(分别为P=0.02和<0.001)。在6个月,安慰剂组的LVEF明显高于硫胺素组(38%;95%CI:36%,39%与35%相比;95%CI:33%,37%,P=0.047)在调整基线测量值之后。明尼苏达州心力衰竭患者评分无显著差异,步行距离6分钟,和N端脑利钠肽激素原浓度在2组间比较。补充硫胺素组的一名患者(2.9%)在6个月时死亡,对照组中没有一名患者死亡。
在心力衰竭和LVEF降低的非卧床患者中,补充硫胺素6个月没有改善LVEF,生活质量,或运动能力,尽管硫胺素浓度增加。这些发现不支持常规硫胺素补充治疗HF和降低LVEF。该试验在clinicaltrials.gov注册为NCT00959075。
Thiamin, a water-soluble B-complex vitamin, functions as a coenzyme in macronutrient oxidation and in the production of cellular ATP. Data suggest that
thiamin depletion occurs in heart failure (HF). Therefore,
thiamin supplementation in HF patients may improve cardiac function.
We sought to determine whether oral thiamin supplementation improves left ventricular ejection fraction (LVEF), exercise tolerance, and quality of life among patients with HF and reduced LVEF.
In this prospective, multicenter, double-blind, placebo-controlled randomized
trial, eligible ambulatory patients with HF and reduced LVEF were recruited from 4 academic and community hospitals between 2010 and 2015. Participants were randomly assigned to receive either 200 mg oral thiamin mononitrate per day or placebo for 6 mo.
Sixty-nine patients (mean ± SD age: 64 ± 12 y; 83% men; LVEF: 37% ± 11%) were randomly assigned: 34 received placebo and 35 received thiamin supplementation. Erythrocyte
thiamin pyrophosphate and urine
thiamin concentrations were significantly higher in the supplemented group than in the placebo group at 6 mo (P = 0.02 and <0.001, respectively). At 6 mo, LVEF was significantly higher in the placebo group than in the thiamin group (38%; 95% CI: 36%, 39% compared with 35%; 95% CI: 33%, 37%, P = 0.047) after adjusting for baseline measurements. There were no significant differences in Minnesota Living with Heart Failure score, distance walked in 6 min, and N-terminal prohormone of brain natriuretic peptide concentrations between the 2 groups. One patient (2.9%) in the thiamin-supplemented group and none in the control group died at 6 mo.
In ambulatory patients with HF and reduced LVEF, thiamin supplementation for 6 mo did not improve LVEF, quality of life, or exercise capacity, despite increases in thiamin concentrations. These findings do not support routine thiamin supplementation in the treatment of HF and reduced LVEF.This
trial was registered at clinicaltrials.gov as NCT00959075.